The Insulin Express

by Oren Liebermann

  Copyright © 2017 by Oren Liebermann

  Foreword © 2017 by Dr. Sanjay Gupta

  A portion of the money received for every copy sold of The Insulin Express goes directly to the American Diabetes Association.

  All rights reserved. No part of this book may be reproduced in any manner without the express written consent of the publisher, except in the case of brief excerpts in critical reviews or articles. All inquiries should be addressed to Skyhorse Publishing, 307 West 36th Street, 11th Floor, New York, NY 10018.

  Skyhorse Publishing books may be purchased in bulk at special discounts for sales promotion, corporate gifts, fund-raising, or educational purposes. Special editions can also be created to specifications. For details, contact the Special Sales Department, Skyhorse Publishing, 307 West 36th Street, 11th Floor, New York, NY 10018 or info@skyhorsepublishing.com.

  Skyhorse® and Skyhorse Publishing® are registered trademarks of Skyhorse Publishing, Inc.®, a Delaware corporation.

  Visit our website at www.skyhorsepublishing.com.

  10 9 8 7 6 5 4 3 2 1

  Library of Congress Cataloging-in-Publication Data is available on file.

  Cover design by Jenny Zemanek

  Cover photo credit: iStock

  Print ISBN: 978-1-5107-1848-7

  Ebook ISBN: 978-1-5107-1849-4

  Printed in the United States of America

  Contents

  Foreword

  Preface

  1. Jerusalem

  2. Philadelphia, Pennsylvania

  3. Lansdowne, Pennsylvania

  4. Charlie-Gibbs Fracture Zone, North Atlantic Ocean

  5. Spytkowice, Poland

  6. Nairobi, Kenya

  7. Bethlehem, West Bank

  8. Bangkok, Thailand

  9. En Route to Annapurna Base Camp, Western Region, Nepal

  10. Matepani Gumba, Pokhara, Nepal

  11. Lakeside, Pokhara, Nepal

  12. Pokhara, Nepal

  Photo Insert

  13. Shrewsbury, New Jersey

  14. Chiang Rai, Thailand

  15. Luang Prabang, Laos

  16. Phnom Penh, Cambodia

  17. Saigon, Vietnam

  18. Hong Kong

  19. Great Wall of China

  20. Beijing, China

  21. Tokyo, Japan

  22. Machu Picchu, Peru

  23. Salta, Argentina

  24. Allentown, Pennsylvania

  25. Reykjavik, Iceland

  Epilogue: Gulf of Aqaba

  Acknowledgments

  Appendix

  The names of some locations and people have been changed.

  Foreword

  As doctors, we often get only fleeting snapshots in time of our patients’ lives. They arrive in our clinics, emergency wards, and operating rooms at the culmination of the most important physical and emotional journey of their lives. They are sick, vulnerable, and suddenly reduced to a blurry mess of lab values, imaging results, and diagnoses. It can be disorienting and humbling for the patients and their families.

  Understandably, the physician’s focus is on the immediate threat and how best to deal with it. Still, we rarely get a full appreciation of the incredible story and background that brought the patient to us in the first place. The fact is, we can diagnose our patient as ill, but do not fully appreciate why or how it happened. This is a missing link in the practice of medicine that my colleague Oren Liebermann brilliantly uncovers with The Insulin Express. He provides an incredible backstory to the germination of his own malady. It is true that we know more than ever about the physical impact of diabetes, but Oren wants us to know the emotional toll, as well.

  As I started to read The Insulin Express, I devoured the clues about the beginning symptoms of his illness. With a journalist’s diligence, no detail was too small or unimportant. It was his fastidious journaling throughout a year of triumphs and letdowns which provided the exhilarating spine to his book. As he was trekking through Nepal and climbing toward Annapurna Base Camp, I felt like I was right there with him—concerned for his welfare and wondering why he shed 45 pounds, leaving him continuously exhausted. I could peer up the final 300 steps he needed to climb, even as his body was literally breaking down and devouring itself. I silently urged him to turn back, but cheered at the photo of his success, his blood soaked with sugar.

  If you have diabetes, or face any sort of challenge, The Insulin Express is the dose of inspiration you need to be reminded of what is possible.

  It is not too often that a writer with the candor, biting sarcasm, and narrative style of Oren Lieberman writes a book so deeply personal. At first, The Insulin Express is a sweeping travelogue of a man who was born to travel and who sacrifices a great deal to do so. Oren writes with the irreverence and brisk pace of the world traveler he set out to be. Again, striking details are never omitted, but there is a relentless nature to his narrative, as he candidly shares his entry into the world of journalism and the resulting trials along the way. It is about relationships with friends, colleagues, and new loves.

  It is also, however, an anatomy of an illness that leaves him with the option of possibly dying in a dusty, remote Nepalese clinic, or coming out the other side stronger and more inspired than before. We will all have challenges in our lives; even the most blessed among us. It is not the challenge upon which we will reflect in our later years, however, but how we behaved in the face of those obstacles. And, for that, Oren has valuable lessons to share with all his readers.

  “Deep within all of us lies the truth.” This is the note I scribbled halfway through the book. On some subconscious level, Oren likely knew what was happening deep within his body even if his brain, like all of ours, is wired for denial. And in there lies one of the lessons. The stories of our patients, chock full of details, provide not only a wonderful narrative, but also critical insights into ourselves—if we just take the time to share and listen.

  —Dr. Sanjay Gupta, Chief Medical Correspondent for CNN

  Preface

  I had always wanted to write a book. I never quite knew what book it was that I would write, but that seemed less important than the actual intent to write it. The story would sort itself out once I put pen to paper. (When I was in fourth grade, I wrote the first four pages of a novel. It was one of the longest things I had ever written. I showed it to my dad, who pointed out that it had a lot of curse words. I was writing an adult novel, I reasoned, and adults curse.)

  Suffice it to say this is certainly not the book I thought I would write. I had always dreamt of writing a book about my life as a test pilot. I hate to break it to my younger self, but this is not that book.

  When we started traveling, I had a vague notion that I wanted to write a book about the trip. What I couldn’t figure out was why my story was compelling. On Valentine’s Day 2014, the day I was officially diagnosed with diabetes, I got my answer.

  Since then, I have vowed to spend every Valentine’s Day overseas as a way of reminding myself—and my disease—who’s in charge here.

  This is my life, just as certainly as your life is your own, and I will not have my decisions dictated to me by diabetes. I hope you find similar inspiration somewhere within these pages.

  Chapter 1

  June 13, 2011

  31°47’05.8”N 35°12’57.0”E

  Jerusalem

  The Aussies are drunk again.

  For a fourth straight night, they consume an ungodly amount of alcohol—mostly beer, but occasionally they mix in something more potent for variety, perhaps a vodka or licorice arak. They are waging war on their livers, attacking with wave upon wave of alcoholic beverage. Since we’re in Jerusalem, I can only assume this is a holy war, though what deity they fight fo
r or what set of beliefs they proselytize I have not yet divined. They drink with the fervor and fanaticism of Crusaders, except instead of trying to rid the Middle East of one particular religious group or another, they are trying to vanquish the alcohol supply here.

  Based on what I remember of Mrs. Bejda’s tenth grade biology class, their livers are bound to give up at some point. They must, anatomically speaking, suffer alcohol poisoning eventually. But I see no signs of such mortal weakness. They drink with a swagger and confidence that is uniquely Australian, confident that tomorrow will come no matter what conglomeration of drinks they imbibe.

  Nico seems to be the ringleader. Tall and brunette, she is incredibly fun and, somehow, in very good shape. Her sinewy arms and legs remind me of an Olympic high jumper armed with a trigger-happy smile. She has trained her body to metabolize grain alcohol into pure muscle, a trick I remind myself to learn. Nico’s fitness hides her age—she could be anywhere between twenty-five and forty—old enough to have built up a resistance to the deleterious effects of alcohol, yet young enough to ignore them (though I suspect she is closer to our late twenties). She is gregariously loud and laughs between frequent sips of booze. My fiancée, Cassie, and I like her instantly.

  Sim—short for Simeon—is her partner in crime. Also tall and lean, but much quieter and more laid-back. He sports cropped dirty blond hair and a boyishly short beard. Nothing bothers him. I suspect he is a good surfer, no matter what his blood-alcohol content. He stays with Nico on every drink. Claire, the final member of Team Aussie on this night, is shorter, quieter, and perhaps inwardly confident that there is a limit to how much one should drink in a night and maybe we crossed that limit a few hours back, somewhere between the third beer and fourth shot.

  The three Australians have been traveling for months, working their way across parts of Asia and the Middle East.

  “We smashed Jordan,” says Nico, laughing.

  “Yeah, definitely,” Sim agrees.

  “Absolutely smashed Jordan.”

  “Smashed?” I ask, quite sure that no one has taken an oversized sledgehammer or other such destructive device to the Hashemite Kingdom in recent days. Now that I am on vacation, I have no reason to keep up with the news, but I feel like that one would’ve come to my attention.

  “Oh, right, sorry,” Nico says. “Smashing is getting really pissed somewhere. Really, really drunk. We smashed Jordan.” She and Sim lapse into giggles, as if remembering a covert first kiss or an embarrassing secret.

  “I thought Jordan didn’t have any alcohol.”

  “It doesn’t. We found a place that let us drink in a back room with no windows so no one could see us.”

  I don’t whistle in appreciation of their commitment to finding booze, but I should. There are no limits to how far they will go to drink. Their daily routine is like clockwork. I could set my watch by the time they wake up hungover, find breakfast, hydrate, then get back to drinking. The only variable in their day that I observe is the time they pass out at night. I suspect even this can be reduced to a quantifiable formula through the calculus of alcoholic absorption into the bloodstream based on what they drink, how fast they drink it, and how long they wait in between drinks. Most nights the answers are beer, fast, and not at all.

  They don’t bother with the tediousness of seeing the sites of Jerusalem. Who cares about the site where Jesus was betrayed if you can check out the pub where Judas drank afterward? The Western Wall and the Dome of the Rock, a mere fifteen-minute walk from our hostel, mean far less to them than Carlsberg and Maccabi beer. The Church of the Holy Sepulchre, the City of David—these are all insignificant. You can read about them later in a tour book or see them online. With today’s broadband speed and accessibility, you can have a high-resolution image of these sites or an HD video on your smartphone in seconds. Besides, the holy sites aren’t going anywhere. The beer is. They have drunk their way through half the world, and now they are steadily working on the other half.

  I am impressed. I have never seen such single-minded determination to do one thing and one thing alone, even when surrounded with so many other options. When Sir Edmund Hillary was climbing Everest for the first time, all he could really do was go up. When Neil Armstrong was on his way to the moon, he had no choice but to proceed. Here the Aussies have a whole country full of things they’ve never seen or done, and yet they focus the sum of their not inconsiderable energies on the imbibing of distilled and fermented spirits. Their BAC must be somewhere north of completely shitfaced, but here they are, cackling and chatting their way through another half-liter of sub-par Israeli beer.

  The peer pressure is enormous, even if completely unintentional. They don’t need me to drink with them, but I join the fun and drink anyway, knowing full well they are seasoned veterans at this, while I wallow in my newly discovered amateur status.

  Once I tried to keep up with a friend of mine who could easily hold down more booze than I could. Mitch was a high school friend whom I hadn’t seen since long before we both turned twenty-one. He always outweighed me by a good forty pounds, and at our friend’s wedding I learned exactly how much he could outdrink me too. The groom found me twenty minutes later, lying face up on a sidewalk next to a puddle of my evacuated stomach contents. When Cassie came looking for me, he jovially informed her that he had called me a cab. Cassie was livid, first at my sorry state, and second at the fact that my state forced the groom to call me a cab. Any mention that I was being tried twice for the same crime and that constitutional amendments have, for centuries, prohibited double jeopardy would’ve earned me a swift and severe ass-kicking. I kept my mouth shut and accepted the verbal lacerations as fair punishment.

  Maybe it wouldn’t have been so bad if I hadn’t screwed up so colossally the next morning. We had an early flight back home. I dropped Cassie off at check-in, then went to return our rental car. In that ten-minute difference, she made the flight and I didn’t. I somehow found a way to feel worse than my hangover. To top it off, the entire groom’s family was on my flight, and they knew exactly what had happened.

  I push those fleeting thoughts aside as I keep up with the Aussies. One must never think of the past while halfway through an all-night drinking session.

  In between rounds of whatever alcohol happens to be the cheapest at the moment, I begin to pick up some Australian. Theoretically, they speak English Down Under, but to my American ears, they speak a dialect of English that uses enough new words and phrases to qualify as its own language.

  “You piked last night,” Nico yells at Sim.

  “I did not pike!” Sim retorts.

  “Yes, you did, you piker.”

  “I am not a piker!”

  “What the hell is piking?” I manage to interject.

  I learn that piking is calling it a night early, or worse, not going out at all. Pikers are “tired” or “sleepy” or “want to stay in”—all very anti-Down Under concepts from what I can tell. Peer pressure and a steady barrage of insults are the best weapons against piking. “You better not fucking pike!” or “You piker! You piked last night too!” are all good sentences to keep on standby to ward off even the merest thought of piking.

  I dare not pike.

  Not even when I have a damn good reason to pike. Cassie and I signed up for a tour of Masada, Ein Gedi, and the Dead Sea that leaves at 3 a.m. so we can climb the snake path to Masada before sunrise.

  For us, this vacation is a bit of a celebration—I proposed to Cassie two weeks ago on the morning of her graduation from graduate school—and we’re trying to pack in as much sightseeing as possible between trips to visit my family. Cassie was more than a bit surprised to see a ring in the small box in which I had promised to put earrings, and I was more than a bit relieved to finally unweave the web of very delicate lies I had spun to cover both my repeated trips to New York City’s diamond district and the gaping hole in my savings account.

  This is Cassie’s inaugural journey to Israel, which makes it her fi
rst time meeting my cousins, since only my immediate family emigrated to the States. One side of my family greets her with open arms, eager to meet an upcoming addition to the Liebermann clan. The other side spends three hours trying to convince me to call off the engagement simply because Cassie isn’t Jewish. The conversation is distinctly one-sided, partly because I know that arguing won’t change anyone’s opinion, but mostly because I don’t speak Hebrew well enough to explain to them the lunacy of their own position. Yet I understand it just fine.

  They cite texts written more than a few millennia ago and spout scripture they insist be interpreted literally and without the slightest taint of modernity. Their attempts to dissuade me from attending my own upcoming nuptials involve phrases like “silent Holocaust,” which is apparently the theoretical murder of future Jewish children by marrying outside the faith, and they compare my love for Cassie to my love for ice pops, since, according to their strict Orthodox ethos, a relationship with a goy can’t contain real emotion. I allow the conversation to last three hours only because that’s how long I can ignore their incessant psychobabble while I try to remember the days when I enjoyed their company.

  After we rid ourselves of their fundamentalist monologues, we get back to exploring the country where I spent my earliest years. We booked the Masada excursion months ago, and we’ve been looking forward to it as one of the highlights of our trip.

  Surprisingly, the Aussies have decided to venture out and explore a bit, taking a short break from the only activity in which they have shown an active and unyielding interest. They have signed up for the same tour. The drive to Masada will take about an hour, not nearly long enough to catch up on the sleep that we are so willfully sacrificing in the name of Dionysus. This fact stumbles across our subconscious, but we push it down into the darkest recesses of our id for a few more drinks.

  We give in to some combination of exhaustion and intoxication late in the evening. Leaving the last shreds of our sobriety at the bar behind us, we head to bed, letting our circadian rhythms figure out what to do with the few hours of sleep we will get before a day in the desert sun.